- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $388.43 / $1,025.46 / $1,076.75
| Facility | | $388.43 | $1,025.46 | $1,076.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,000.00 / $8,639.91 / $79,506.39
| Facility | | $5,000.00 | $8,639.91 | $79,506.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64,999.35 / $64,999.35 / $64,999.35
| Professional | | $64,999.35 | $64,999.35 | $64,999.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $440.52 / $963.41 / $1,692.36
| Facility | | $440.52 | $963.41 | $1,692.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $388.43 / $1,025.46 / $1,025.46
| Facility | | $388.43 | $1,025.46 | $1,025.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $427.15 / $936.51 / $1,645.13
| Facility | | $427.15 | $936.51 | $1,645.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $554.29 / $1,049.99 / $1,365.44
| Facility | | $554.29 | $1,049.99 | $1,365.44 |